Oct. 1, 2013
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by Kelly Kennedy, USA TODAY

by Kelly Kennedy, USA TODAY

WASHINGTON - More than three years after Congress passed the Affordable Care Act and President Obama signed it into law, the most controversial piece of the law begins Tuesday - the requirement that uninsured Americans buy health insurance - and Health and Human Services Secretary Kathleen Sebelius said the government is ready.

"We're very excited about tomorrow," Sebelius said Monday. "Shutdown or no shutdown, we're ready to go."

"The Affordable Care Act is moving forward," President Obama said Monday in an announcement.

Starting at 8 a.m., visitors to healthcare.gov, the federal government's health care website, will be able to navigate how to shop for and buy health insurance as part of the law, Sebelius said.

Those sites will open even if Congress and the White House can't agree on a government spending plan, Sebelius said. Much of the fight over the spending bill focuses on the law and congressional Republicans' attempts to either kill it or remove funding for it.

The stakes for the health exchanges are high, and there have been some stumbles on the way. In July, the administration acceded to the wishes of business groups and delayed the requirement that employers with more than 50 workers provide health insurance to their employee or pay a fine. Businesses had complained the tax and insurance requirements were too complicated and difficult to implement in time for the Jan. 1. deadline.

While the administration called the delay of the business mandate an acknowledgment of legitimate issues, it also emboldened the law's opponents. They called it a special-interest break and used it, all the way through Monday, as a reason to delay the opening of the exchanges Tuesday.

White House officials and Sebelius have said the exchanges, which are state- and federal-run websites where people can shop for and buy insurance, need to enroll about 7 million Americans to make the rest of the Affordable Care Act succeed. The exchanges open Tuesday and the requirement for individuals to have insurance starts Jan. 1. The exchanges will remain open for people to buy insurance until March 31, 2014.

HHS officials announced some new details for the exchanges Monday, including:

â?¢ Uninsured Americans who aren't sure how much money they will make next year but who believe they will receive a subsidy to help buy insurance can choose a smaller subsidy and then get the rest of it back at tax time if they underestimate. People who earn up to 400% of the federal poverty level are eligible for financial help to pay for insurance.

â?¢ Insurance consumers will not pay the exchanges anything. Instead, the website will help them choose a plan and then go directly to that plan to pay by visiting a private insurer's website or making a phone call.

â?¢ Customers will not have to give up any personal medical information.

Sebelius said she expects some "glitches" with the new technology, though she said it will be manageable and quickly addressed.

"We will fix them and move on," she said.

In a recent interview, Sebelius said she would consider success to be more children with insurance, as well as women who don't have to pay more simply for being a woman. On Monday, she told the story of a nurse who thought she had good insurance, but when her son was born with a heart defect, the family found itself bankrupted by deductibles and co-pays as the baby went in for five surgeries. In the future, Sebelius said, there won't be unexpected costs.

Those who do not have insurance in 2014 will pay a penalty, which will be paid in 2015 after a person files 2014 tax returns.

Here's how the new website works:

â?¢ The siteasks what language you speak, and then offers assistance in 150 languages from Spanish to Mandarin.

â?¢ Visitors will fill out a web-based form, similar to ordering airline tickets or a book online. They will provide their names, the names of their dependents and other basic information, such as an address and Social Security number. Officials stressed the security of the system, which is similar to the online site used by Medicare recipients. This will also determine a consumer's eligibility for a subsidy.

â?¢ The site asks questions about what kind of insurance coverage a customer wants or needs. It then provides options based on a customer's preferences. Consumers may save different plans in a "shopping cart," just as those who use online sites such as Amazon.com or BarnesandNoble.com. That allows consumers to decide at a later time if they want to make a purchase.

â?¢ Plans can be compared on a side-by-side basis, which allows consumers to see what private insurer is selling the plan, how much the plan will cost, what benefits are covered, and what the co-payments, deductibles and premiums will be. The page features items that can be clicked for more explanations of each.

Consumers can begin the process, save their answers, and continue working on it later. HHS officials stressed that people should take their time so they feel comfortable with their choices. At any point in the process, customers may click a link to get online help from a real person, or call a phone number for help. For extra assistance, they may ask for one-on-one in-person assistance.